| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
15,732 |
15,667 |
$482K |
| T4523 |
Adult size brief/diaper lg |
6,008 |
5,980 |
$396K |
| A4554 |
Disposable underpads |
13,875 |
13,815 |
$385K |
| T4524 |
Adult size brief/diaper xl |
3,283 |
3,273 |
$230K |
| L3030 |
Foot arch support remov prem |
1,353 |
1,200 |
$138K |
| T4539 |
Reuse diaper/brief any size |
3,883 |
3,840 |
$95K |
| T4522 |
Adult size brief/diaper med |
1,642 |
1,639 |
$77K |
| T4537 |
Reusable underpad bed size |
1,424 |
1,412 |
$40K |
| L3216 |
Orthoped ladies shoes dpth i |
359 |
342 |
$26K |
| A4927 |
Non-sterile gloves |
2,939 |
2,898 |
$14K |
| A4253 |
Blood glucose/reagent strips |
1,001 |
995 |
$8K |
| A4259 |
Lancets per box |
479 |
473 |
$1K |
| A5500 |
Diab shoe for density insert |
23 |
13 |
$332.48 |
| A5512 |
Multi den insert direct form |
23 |
13 |
$169.16 |